Delayed Orbital Floor Reconstruction Using Mirroring Technique and Patient-Specific Implants: Proof of Concept

Area of Science:

• Plastic Surgery
• Biomedical Engineering
• Ophthalmology

Background:

• Enophthalmos is a severe complication after orbital floor reconstruction.
• Secondary orbital reconstruction aims to restore globe symmetry, function, and aesthetics.
• Existing methods may not fully address complex orbital floor defects.

Purpose of the Study:

• To present a computer-assisted method for secondary orbital floor reconstruction.
• To evaluate the efficacy of patient-specific implants (PSI) in correcting enophthalmos.
• To compare PSI outcomes with traditional stock implants.

Main Methods:

• A four-step protocol involving mirroring healthy orbit CT scans, virtual implant design, computer-aided manufacturing (CAM) of custom implants (titanium or HDPE), and surgical insertion.
• Utilized Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) for implant fabrication.
• Assessed clinical outcomes using 3dMD photogrammetry and CT scans in 13 patients.

Main Results:

• Patients treated with PSI showed a mean improvement of 3.04 mm in globe protrusion (range 0.3-6 mm).
• No major complications were reported in the PSI group.
• The PSI group demonstrated better outcomes compared to the control group using stock implants.

Conclusions:

• Computer-assisted orbital floor reconstruction with PSI is a viable method for delayed reconstruction of complex orbital defects.
• This technique successfully restores globe position and improves aesthetic outcomes.
• PSI offers a promising solution for managing enophthalmos and related complications.